EP1337297B1 - Appareil de stimulation cardiaque - Google Patents
Appareil de stimulation cardiaque Download PDFInfo
- Publication number
- EP1337297B1 EP1337297B1 EP01983893A EP01983893A EP1337297B1 EP 1337297 B1 EP1337297 B1 EP 1337297B1 EP 01983893 A EP01983893 A EP 01983893A EP 01983893 A EP01983893 A EP 01983893A EP 1337297 B1 EP1337297 B1 EP 1337297B1
- Authority
- EP
- European Patent Office
- Prior art keywords
- ventricle
- heart
- electrode
- stimulating device
- pacing circuit
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Lifetime
Links
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/3627—Heart stimulators for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
- A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
- A61N1/3682—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions with a variable atrioventricular delay
Definitions
- the present invention relates to an implantable cardiac stimulating device according to the preamble of claim 1. More precisely, the invention concerns a stimulating device having the capabability to sense and stimulate the right atrium, to sense the left atrium, and to sense and stimulate the right and left ventricles respectively in accordance with the preamble of the main claim.
- pacers are arranged to stimulate the right ventricle of the heart, but it is also known to stimulate the left ventricle. In particular for the treatment of congestive heart failure or other severe cardiac failures it is known to stimulate the left ventricle, or both ventricles, in order to optimize the hemodynamic performance of the heart.
- US-A-5 720 768 describes different possible electrode positions in order to stimulate or sense the different chambers of the heart. It is also disclosed that the conduction time from right atrium to left atrium may be observed and the left atrium may be paced if the conduction time is too long.
- the purpose of the present invention is to provide a cardiac pacemaker which provides an AV-interval which is optimized for the left side of the heart.
- a first AV-interval is started at paced or sensed events occuring in the right atrium.
- the atrial depolarization has conducted to the left atrium this is sensed through an electrode located in the coronary sinus, preferably the proximal portion thereof.
- a second AV-interval optimized for the left heart is started.
- this AV-interval has elapsed the left ventricle is stimulated with the left heart AV-interval. If no atrial event is detected on the coronary sinus electrode the initially started first AV-interval, AV1, will be used.
- the AV-interval for the left side of the heart is optimized without any need for stimulating the left atrium.
- Fig 1 shows an implantable cardiac stimulating device, hereinafter also called a pacemaker system 1 , according to the invention.
- the pacemaker system 1 comprises a pulse generator 2 and leads 17, 18, 19, 20.
- a pacing circuit 3 is enclosed in the pulsegenerator 2.
- the pacing circuit 3, and thereby the pulse generator is adapted to be connected to lead 19 with electrode 23.
- Fig 1 shows such an electrode 23 which is connected to the pacemaker via lead 19.
- the first electrode 23 is adapted to be positioned to stimulate the left ventricle 9 of the heart 5.
- the pacing circuit 3 is also adapted to be connected to a second electrode 22.
- Fig 1 shows such a second electrode 22 connected to the pacing circuit 3 via a lead 18.
- the second electrode 22 is positioned to sense depolarizations the left atrium of the heart 5.
- the pacing circuit 3 is further adapted to be connected to a third electrode 21.
- Fig 1 shows such a third electrode 21 connected to the pacing circuit 3 via a lead 17.
- the third electrode 21 is positioned to sense depolarizations the right atrium of the heart 5.
- a sensed or paced event originating from right atrial electrode 21 will start a first AV-interval.
- the first AV-interval, AV1 may be set to optimize the RA-RV contraction, the RA-LV contraction or the RA-both RV,LV contraction in the absence of a LA sense. In the normal case this right atrial depolarization will be conducted to the left atrium and be sensed by detecting means 12 via lead 18 and electrode 22.
- AV1 When the depolarization is detected at the left atrium the first ongoing AV-interval, AV1, will be superseded by a second AV delay, AV2, specifically optimized for the left side of the heart 5. This will provide a correct left side AV interval also if there is slow conduction from right atrium 6 to left atrium 7. In the case that no P-wave is detected from left atrial electrode 22 then said initially started first AV-interval will be used. At the end of the first AV-interval, AV1, a stimpulse is delivered to the left ventricle via lead 19 and electrode 23.
- the leads 17, 18, 19 and 20 may include more than one electrical conductor in order to allow for bipolar pacing and sensing. In that case electrodes 21, 22, 23, and 24 will have two active surfaces each.
- the system also comprises a lead 20 with electrode 24 for stimulation of the right ventricle 8 and for detection of R-waves from the right ventricle.
- the right ventricle may be paced with an AV-delay optimized for the right heart and the left ventricle may be paced with an AV-delay optimized for the left heart.
- both ventricles are paced synchronously with an AV-interval optimized for the left ventricle.
- leads 18 and 19 are integrated into one lead 25 comprising electrodes 23 and 22 for placement in left ventricle and left atrium respectively.
- differential sensing is applied between electrodes 23 and 22 and discrimination between left ventricular P-waves and R-waves is accomplished through analysis of timing and morphology of the differential signal.
- This sensing concept is described in US-A-5 571 143 and in US-A-5 871 507 which are hereby incorporated by reference.
- the left atrial contraction is detected as a Far-Field P-Wave, FFPW, by sensing means 14 via lead 19 and electrode 23.
- Morphology discrimination may be applied to discriminate between left ventricular R-waves and
Landscapes
- Health & Medical Sciences (AREA)
- Cardiology (AREA)
- Hospice & Palliative Care (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Radiology & Medical Imaging (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Electrotherapy Devices (AREA)
Claims (5)
- Dispositif (1) implantable de stimulation cardiaque comprenant :un boítier (2), un circuit (3) d'entraínement et des dérivations (17, 18, 19,20),le circuit (3) d'entraínement comprenant un circuit (4) de commande et des moyens (10, 13, 15) de sortie de stimulation et des moyens (11, 12, 14, 16) de détection comprenant des moyens (12) d'exploration de l'oreillette gauche, destinés à détecter des dépolarisations cardiaques, le circuit (3) d'entraínement étant conçu pour être relié à une première électrode (23) à mettre en position pour stimuler et détecter des dépolarisations dans le ventricule (9) gauche du coeur (5), le circuit d'entraínement étant conçu pour être relié à une deuxième électrode (22) à mettre en position pour détecter des dépolarisations de l'oreillette gauche, le circuit d'entraínement étant apte à être relié à une troisième électrode (21) à mettre en position dans l'oreillette (6) droite et destinée à stimuler et à détecter des dépolarisations, caractérisé en ce qu'une dépolarisation détectée ou entraínée de l'oreillette (6) droite fait débuter un premier retard AV, AV1, à la fin duquel une impulsion de stimulation est envoyée au ventricule gauche le premier retard AV étant remplacé par un deuxième retard AV, AV2 optimisé pour le côté gauche du coeur, après la détection d'une dépolarisation de l'oreillette gauche par les moyens (12) d'exploration de l'oreillette gauche.
- Dispositif (1) implantable de stimulation cardiaque suivant la revendication 1, caractérisé en ce que le circuit (3) d'entraínement comprend des moyens (16) de détection de dépolarisation du ventricule droit et des moyens (15) de stimulation du ventricule droit.
- Dispositif (1) implantable de stimulation suivant la revendication 2, caractérisé en ce que le ventricule (8) droit est stimulé en même temps que le ventricule (9) gauche.
- Dispositif (1) implantable de stimulation suivant la revendication 2, caractérisé en ce que ventricule (8) droit est stimulé avec l'intervalle AV optimisé pour le coeur droit, que l'on fait débuter sur une dépolarisation de l'oreillette droite et en ce que le ventricule (9) gauche est stimulé par un intervalle AV de coeur gauche, qui commence à la détection d'une dépolarisation de l'oreillette gauche et si une dépolarisation de l'oreillette gauche n'est pas détectée, la stimulation du ventricule gauche est coordonnée à la stimulation du ventricule droit.
- Dispositif (1) implantable de stimulation cardiaque suivant l'une quelconque des revendications précédentes, caractérisé en ce que des dépolarisations de l'oreillette gauche sont détectées sous la forme de FFPW sur des signaux collectés par une électrode (23) placée dans le côté gauche du coeur.
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
SE0004240A SE0004240D0 (sv) | 2000-11-17 | 2000-11-17 | A cardiac stimulating device |
SE0004240 | 2000-11-17 | ||
PCT/SE2001/002548 WO2002040097A1 (fr) | 2000-11-17 | 2001-11-15 | Appareil de stimulation cardiaque |
Publications (2)
Publication Number | Publication Date |
---|---|
EP1337297A1 EP1337297A1 (fr) | 2003-08-27 |
EP1337297B1 true EP1337297B1 (fr) | 2005-01-12 |
Family
ID=20281882
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP01983893A Expired - Lifetime EP1337297B1 (fr) | 2000-11-17 | 2001-11-15 | Appareil de stimulation cardiaque |
Country Status (5)
Country | Link |
---|---|
US (1) | US7047073B2 (fr) |
EP (1) | EP1337297B1 (fr) |
DE (1) | DE60108417T2 (fr) |
SE (1) | SE0004240D0 (fr) |
WO (1) | WO2002040097A1 (fr) |
Families Citing this family (55)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US8244370B2 (en) * | 2001-04-13 | 2012-08-14 | Greatbatch Ltd. | Band stop filter employing a capacitor and an inductor tank circuit to enhance MRI compatibility of active medical devices |
US9295828B2 (en) | 2001-04-13 | 2016-03-29 | Greatbatch Ltd. | Self-resonant inductor wound portion of an implantable lead for enhanced MRI compatibility of active implantable medical devices |
WO2002083016A1 (fr) | 2001-04-13 | 2002-10-24 | Surgi-Vision, Inc. | Systemes et procedes d'interventions guidees par resonance magnetique |
SE0202214D0 (sv) * | 2002-07-12 | 2002-07-12 | St Jude Medical | A cardiac stimulating device |
US20060247693A1 (en) | 2005-04-28 | 2006-11-02 | Yanting Dong | Non-captured intrinsic discrimination in cardiac pacing response classification |
US7774064B2 (en) | 2003-12-12 | 2010-08-10 | Cardiac Pacemakers, Inc. | Cardiac response classification using retriggerable classification windows |
US8521284B2 (en) | 2003-12-12 | 2013-08-27 | Cardiac Pacemakers, Inc. | Cardiac response classification using multisite sensing and pacing |
US7123960B2 (en) * | 2003-12-22 | 2006-10-17 | Cardiac Pacemakers, Inc. | Method and system for delivering cardiac resynchronization therapy with variable atrio-ventricular delay |
US7203540B2 (en) * | 2003-12-22 | 2007-04-10 | Cardiac Pacemakers, Inc. | Method and system for setting cardiac resynchronization therapy parameters |
US7706866B2 (en) | 2004-06-24 | 2010-04-27 | Cardiac Pacemakers, Inc. | Automatic orientation determination for ECG measurements using multiple electrodes |
US7509170B2 (en) * | 2005-05-09 | 2009-03-24 | Cardiac Pacemakers, Inc. | Automatic capture verification using electrocardiograms sensed from multiple implanted electrodes |
US7917196B2 (en) | 2005-05-09 | 2011-03-29 | Cardiac Pacemakers, Inc. | Arrhythmia discrimination using electrocardiograms sensed from multiple implanted electrodes |
US7890159B2 (en) * | 2004-09-30 | 2011-02-15 | Cardiac Pacemakers, Inc. | Cardiac activation sequence monitoring and tracking |
US7797036B2 (en) * | 2004-11-30 | 2010-09-14 | Cardiac Pacemakers, Inc. | Cardiac activation sequence monitoring for ischemia detection |
US7457664B2 (en) * | 2005-05-09 | 2008-11-25 | Cardiac Pacemakers, Inc. | Closed loop cardiac resynchronization therapy using cardiac activation sequence information |
US7613514B2 (en) * | 2005-04-19 | 2009-11-03 | Cardiac Pacemakers, Inc. | Selective resynchronization therapy optimization based on user preference |
US20070129762A1 (en) * | 2005-12-01 | 2007-06-07 | Seth Worley | Cardiac pacemaker with dynamic conduction time monitoring |
WO2007089176A1 (fr) * | 2006-01-31 | 2007-08-09 | St. Jude Medical Ab | Système et procédé de détection d'événements électriques dans des cavités cardiaques |
US8527048B2 (en) | 2006-06-29 | 2013-09-03 | Cardiac Pacemakers, Inc. | Local and non-local sensing for cardiac pacing |
US7580741B2 (en) * | 2006-08-18 | 2009-08-25 | Cardiac Pacemakers, Inc. | Method and device for determination of arrhythmia rate zone thresholds using a probability function |
US8712507B2 (en) * | 2006-09-14 | 2014-04-29 | Cardiac Pacemakers, Inc. | Systems and methods for arranging and labeling cardiac episodes |
US7941208B2 (en) | 2006-11-29 | 2011-05-10 | Cardiac Pacemakers, Inc. | Therapy delivery for identified tachyarrhythmia episode types |
US7941213B2 (en) * | 2006-12-28 | 2011-05-10 | Medtronic, Inc. | System and method to evaluate electrode position and spacing |
CN101711125B (zh) | 2007-04-18 | 2016-03-16 | 美敦力公司 | 针对非荧光镜植入的长期植入性有源固定医疗电子导联 |
US8265736B2 (en) | 2007-08-07 | 2012-09-11 | Cardiac Pacemakers, Inc. | Method and apparatus to perform electrode combination selection |
US9037239B2 (en) | 2007-08-07 | 2015-05-19 | Cardiac Pacemakers, Inc. | Method and apparatus to perform electrode combination selection |
CN101939051B (zh) | 2008-02-14 | 2013-07-10 | 心脏起搏器公司 | 用于膈刺激检测的方法和装置 |
US10080889B2 (en) | 2009-03-19 | 2018-09-25 | Greatbatch Ltd. | Low inductance and low resistance hermetically sealed filtered feedthrough for an AIMD |
US9108066B2 (en) | 2008-03-20 | 2015-08-18 | Greatbatch Ltd. | Low impedance oxide resistant grounded capacitor for an AIMD |
US8663120B2 (en) * | 2008-04-18 | 2014-03-04 | Regents Of The University Of Minnesota | Method and apparatus for mapping a structure |
US8260395B2 (en) * | 2008-04-18 | 2012-09-04 | Medtronic, Inc. | Method and apparatus for mapping a structure |
US8839798B2 (en) * | 2008-04-18 | 2014-09-23 | Medtronic, Inc. | System and method for determining sheath location |
US8532734B2 (en) * | 2008-04-18 | 2013-09-10 | Regents Of The University Of Minnesota | Method and apparatus for mapping a structure |
US8340751B2 (en) * | 2008-04-18 | 2012-12-25 | Medtronic, Inc. | Method and apparatus for determining tracking a virtual point defined relative to a tracked member |
US8494608B2 (en) | 2008-04-18 | 2013-07-23 | Medtronic, Inc. | Method and apparatus for mapping a structure |
US20100036466A1 (en) * | 2008-08-11 | 2010-02-11 | Pacesetter, Inc. | Lead construction with composite material shield layer |
WO2010042364A2 (fr) * | 2008-10-06 | 2010-04-15 | Cardiac Pacemakers, Inc. | Thérapie de resynchronisation cardiaque dynamique par suivi de la conduction intrinsèque |
US8175681B2 (en) | 2008-12-16 | 2012-05-08 | Medtronic Navigation Inc. | Combination of electromagnetic and electropotential localization |
US8494614B2 (en) | 2009-08-31 | 2013-07-23 | Regents Of The University Of Minnesota | Combination localization system |
US8494613B2 (en) | 2009-08-31 | 2013-07-23 | Medtronic, Inc. | Combination localization system |
US8355774B2 (en) * | 2009-10-30 | 2013-01-15 | Medtronic, Inc. | System and method to evaluate electrode position and spacing |
US9931514B2 (en) | 2013-06-30 | 2018-04-03 | Greatbatch Ltd. | Low impedance oxide resistant grounded capacitor for an AIMD |
US10272252B2 (en) | 2016-11-08 | 2019-04-30 | Greatbatch Ltd. | Hermetic terminal for an AIMD having a composite brazed conductive lead |
US11198014B2 (en) | 2011-03-01 | 2021-12-14 | Greatbatch Ltd. | Hermetically sealed filtered feedthrough assembly having a capacitor with an oxide resistant electrical connection to an active implantable medical device housing |
US10350421B2 (en) | 2013-06-30 | 2019-07-16 | Greatbatch Ltd. | Metallurgically bonded gold pocket pad for grounding an EMI filter to a hermetic terminal for an active implantable medical device |
US9427596B2 (en) | 2013-01-16 | 2016-08-30 | Greatbatch Ltd. | Low impedance oxide resistant grounded capacitor for an AIMD |
US10596369B2 (en) | 2011-03-01 | 2020-03-24 | Greatbatch Ltd. | Low equivalent series resistance RF filter for an active implantable medical device |
US9381362B2 (en) | 2012-01-20 | 2016-07-05 | Medtronic, Inc. | Modifying atrioventricular delay based on activation times |
USRE46699E1 (en) | 2013-01-16 | 2018-02-06 | Greatbatch Ltd. | Low impedance oxide resistant grounded capacitor for an AIMD |
US9597513B2 (en) | 2014-10-24 | 2017-03-21 | Medtronic, Inc. | Sensing and atrial-synchronized ventricular pacing in an intracardiac pacemaker |
US9592392B2 (en) | 2014-10-24 | 2017-03-14 | Medtronic, Inc. | Sensing and atrial-synchronized ventricular pacing in an intracardiac pacemaker |
US9468766B2 (en) | 2014-10-24 | 2016-10-18 | Medtronic, Inc. | Sensing and atrial-synchronized ventricular pacing in an intracardiac pacemaker |
US10249415B2 (en) | 2017-01-06 | 2019-04-02 | Greatbatch Ltd. | Process for manufacturing a leadless feedthrough for an active implantable medical device |
US10912945B2 (en) | 2018-03-22 | 2021-02-09 | Greatbatch Ltd. | Hermetic terminal for an active implantable medical device having a feedthrough capacitor partially overhanging a ferrule for high effective capacitance area |
US10905888B2 (en) | 2018-03-22 | 2021-02-02 | Greatbatch Ltd. | Electrical connection for an AIMD EMI filter utilizing an anisotropic conductive layer |
Family Cites Families (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4856524A (en) | 1988-08-29 | 1989-08-15 | Intermedics, Inc. | A-V responsive rate adaptive pacemaker |
US5179949A (en) | 1990-12-07 | 1993-01-19 | Raul Chirife | Cardiac pacemaker with automatic a-v programming for optimization of left heart a-v interval |
SE9203284D0 (sv) | 1992-11-04 | 1992-11-04 | Siemens Elema Ab | Hjaertstimulator |
US5720768A (en) * | 1996-05-22 | 1998-02-24 | Sulzer Intermedics Inc. | Dual chamber pacing with interchamber delay |
US5871507A (en) | 1997-06-06 | 1999-02-16 | Pacesetter Ab | Implantable cardiac assist device having differential signal detection between unipolar atrial and ventricular leads using signal morphology analysis |
US6122545A (en) | 1998-04-28 | 2000-09-19 | Medtronic, Inc. | Multiple channel sequential cardiac pacing method |
-
2000
- 2000-11-17 SE SE0004240A patent/SE0004240D0/xx unknown
-
2001
- 2001-11-15 EP EP01983893A patent/EP1337297B1/fr not_active Expired - Lifetime
- 2001-11-15 DE DE60108417T patent/DE60108417T2/de not_active Expired - Lifetime
- 2001-11-15 WO PCT/SE2001/002548 patent/WO2002040097A1/fr active IP Right Grant
- 2001-11-15 US US10/432,109 patent/US7047073B2/en not_active Expired - Fee Related
Also Published As
Publication number | Publication date |
---|---|
DE60108417D1 (de) | 2005-02-17 |
DE60108417T2 (de) | 2005-12-29 |
US20040064159A1 (en) | 2004-04-01 |
EP1337297A1 (fr) | 2003-08-27 |
WO2002040097A1 (fr) | 2002-05-23 |
SE0004240D0 (sv) | 2000-11-17 |
US7047073B2 (en) | 2006-05-16 |
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